Lollipops

Let's be completely clear on this: we don't learn to like sugar. We are born with chemical receptors on our taste buds that, when they are contacted by sugar, send a signal directly to our brains. That signal does many things, including giving us a sense of well-being and relief from discomfort.

As an aside, the lab where I used to work has helped to figure out the truth about our taste buds. A brilliant scientist I worked with explains on her website that what we were taught about certain tastes having specific locations on the tongue (like sweet in front and bitter in the back) is bunk. Part of the most recent research on taste shows that there is a large genetic component to what we can and can't taste. Though our taste sensitivities can change during our lifetime, it seems that we are all born with a basic toolbox.

In the hospital, we have been using sugar water to help sick babies get through painful procedures. It really seems to help. While giving kids sugar water in the office isn't standard procedure, I think there is a medical benefit to some of the lollipops I give out.

I have posted before about 'concrete thinking' and the inability of children at certain developmental stages to predict the future and prepare for it. So an empathic approach to a child who has just had an immunization or had a splinter removed required us to see that the procedure came as an unpleasant surprise to them. They have a normal physiologic response to a sudden and unexpected painful event: shock. (It's not as bad as the shock we go into when we have an overwhelming infection, or some other really serious medical problem.) Our blood pressure drops, we feel weak, our hearts race, and our blood sugar goes haywire. In the intensive care unit, careful management of a shock victim's blood sugar can be very helpful.

After an unfortunate surprise, the lollipop causes a brief little rise in blood sugar. From a lollipop, the sugar is absorbed directly into the bloodstream through the tongue and mouth, and doesn't have to get through the digestive system, which would be much slower. So I think they get some quick pain relief like the babies as well as a rise in their blood sugar that really seems to make them feel better.

This is why I don't give out sugar-free lollipops. They just can't work the same way. (In fact, I do have some that are sugar-free for my diabetic patients. I keep them in a cabinet.)

Each Dum-Dum lollipop has less than 25 calories. Even for a kid, this isn't a significant risk for weight gain. To gain a pound, we'd have to eat about 150 of them. One lollipop will not cause tooth decay.

And, of course, there are behavioral aspects of giving out the lollipops. They are an incentive to clean up the toys at the end of a visit and something nice about going to the doctor.

(A lot of parents are concerned that the lollipop will worsen their child's hyperactivity. I have a post coming up that deals with this issue specifically.)

Most of the children in my office are not getting any kind of painful procedure. It's for them that I think the lollipops are most important. It's a reward for good behavior, a way of noticing that they did everything right (or even mostly). It is one of the great failures of parenting that we don't catch our children being good. We point out, sometimes angrily, when they don't do what we want. But somehow we have the irrational expectation that when they're doing what they should, they are somehow rewarded for it. In fact, the child can often feel that you're not noticing them being good, but their misbehavior really gets your attention. In my office, I notice their good behavior, explicitly point out one or two things they did that were good, and reward them for it. Since I can't give them the most treasured reward—a parent's attention—I have to get by with candy on a stick. Besides, they taste really good.





The photograph at the top is from my collection and is by Weegee.

Kicking the Blocks

It's easy to find examples of bad parenting. Much as each of us might love our own parents, we all can remember incidents (maybe isolated, maybe not) from our own childhoods in which their instincts weren't, well, optimal. So when I'm a witness to particularly good parenting, it makes an impression on me, and I usually learn something.

The 3-year-old was building rockets out of the wooden blocks I have in the room. Some of them were 10 blocks tall. He was so proud of these that he went out into the hall to tell me about them. He liked that I went to see them and was appropriately amazed by how tall they were.

His brother, almost 5, was in the room assembling a puzzle, but he kept looking over at the younger one, especially when I came in to look at his rockets. Their perceptive mother was there, too. She didn't hesitate to address her older son, who seemed occupied with his puzzle. She said, "Kevin, if you knock over your brother's blocks, you won't get a lollipop." At that moment, this seemed like a comment that came out of the blue. I wondered why she didn't warn him about setting fire to the building, too, as a reason to miss a treat.

I haven't tried to disguise where this is going, so don't be disappointed that there is no surprise twist to this story. As soon as the little brother and I started talking about his rockets, his brother calmly stood up, walked over and kicked the blocks down. He had a giant smile when he did this. Afterwards, he stood and admired his work. The younger brother gave a quick cry, but I told him I'd help put them back together and sat on the floor and started to make rockets with him.

His mother said, "You won't get a lollipop today."

This brought on a vigorous near-tantrum, in which he repeatedly asked, "Why don't I get a lollipop? It's not fair." This continued for a full minute or two before he sulked off into a corner. The rule in my office is that all the toys need to be picked up before anybody gets lollipops. So he said, "What if I pick up the toys? Will I get a lollipop?" His mother thought for a moment before saying that he would if he picked up the toys and apologized to his brother. When the visit came to a close, he was still sulking as his little brother and I picked up the blocks and toys. Kevin moved the blocks around with his feet.

As they left, his brother chose a lollipop from the basket. His mother was unflinching. Kevin got none and was unhappy about it.

At the same time, this mother was rock-solid, yet forgiving. She didn't negotiate or go back on her word. The child's behavior, was age-appropriate. He is just beginning to have an inkling of consequences from actions he can control. But exercising that control is just out of his reach.

So often, from a child's perspective, the rules adults create for them seem arbitrary and unpredictable. New rules appear invented for novel events that they can't expect. At Kevin's age, with his completely immediate concrete thinking, he doesn't have the ability to generalize a basic but vague rule, like 'Don't hit your brother,' and apply the rule to new situations. So an empathic approach allows us to understand that he might reason that the rule doesn't apply to hitting his brother in the car, or while watching TV, and so on. In the incident in my office, his mother made this easier for him by being very specific about the rule. She foresaw what he wanted to do to those tempting towers of blocks. While he clearly heard her, he couldn't make sense of how his action could result in a consequence he didn't like. Now he and his mother will have an example to point to when the issue of actions and consequences comes up again. And it will.



The sweet photograph at the top is not in my collection but is used with permission by the photographer, Courtney Coolidge, who takes great photographs of kids and families.